Renal effects, lithium

Oakley PW, Dawson AH, Whyte IM. Lithium thyroid effects and altered renal handling. J Toxicol Chn Toxicol 2000 38(3) 333-7. 

Lithium Renal lithium excretion sensitive to changes in sodium balance. (Sodium depletion tends to cause ACE inhibitors [NE] Probable reduced renal clearance of lithium increased lithium effect. 

Porter, G. A., and Bennett, W. M. 1989. Drug-induced renal effects of cyclosporine, aminoglycoside antibiotics and lithium Extrapolation of animal data to man. In Nephrotoxicity Extrapolation from in vitro to in vivo, and animals to man, ed. Bach, P. H. and Lock, E. A., 147-170. New York, London Plenum Press. 

Shirley DG, Walter SJ, Sampson B. A micropuncture study of renal lithium reabsorption effects of amiloride and furosemide. Am J Physiol 1992 263 FI 128-Fl 133. 

Martinez-Maldonado M, Stravroulakl-Tsapar A,Tsaparas N. Renal effects of lithium administration In rats alterations In water and electrolyte metabolism and the response to vasopressin and cyclic adenosine monophosphate during prolonged administration. J Lab Clin Med 1975 86 445-461. 

In most cases the mechanism is not known. Stimulators of vasopressin secretion include vincristine, cyclophosphamide, tricyclic antidepressants, nicotine, epinephrine, and high doses of morphine. Lithium, which inhibits the renal effects of vasopressin, also enhances vasopressin secretion. Inhibitors of vasopressin secretion include ethanol, phenytoin, low doses of morphine, glucocorticoids, fluphenazine, haloperidol, promethazine, oxilorphan, and butorphanol. Carba-mazepine has a renal action to produce antidiuresis in patients with central diabetes insipidus but actually inhibits vasopressin secretion via a central action. 

Hemodialysis removes lithium effectively and is indicated for intoxicated patients with seizures or severely abnormal mental status and for patients unable to excrete lithium renally (ie, anephric oranuric patients). Repeated and prolonged dialysis may be necessary because of slow movement of lithium out of the CNS. 

Bedford JJ, Weggery S, Ellis G, McDonald FJ, Joyce PR, Leader JP, Walker RJ. Lithium-induced nephrogenic diabetes insipidus renal effects of amiloride. Clin J Am Soc Nephrol 2008 3 1324-31. 

In clinical use, the major concern regarding lithium use is not efficacy, but rather toxicity. Clinicians and patients are particularly concerned about the potential for renal dysfunction [39 ]. To address this conundrum, a decision analysis based on a systematic review of the literature was performed, and found that lithium initiation and continuation, even in the presence of long-term adverse renal effects, should be recommended in most cases [40 " ]. This appears to also apply to elder subjects after prolonged lithium treatment [4i iiu a> study 42review]... 

The NSAIDs prolong bleeding time and increase the effects of anticoagulants, lithium, cyclosporine, and the hydantoins. These dru may decrease the effects of diuretics or antihypertensive drug >. Long-term use of the NSAIDs with acetaminophen may increase the risk of renal impairment. 

Lithium intoxication can be precipitated by the use of diuretics, particularly thiazides and metola-zone, and ACE inhibitors. NSAIDs can also precipitate lithium toxicity, mainly due to NSAID inhibition of prostaglandin-dependent renal excretion mechanisms. NSAIDs also impair renal function and cause sodium and water retention, effects which can predispose to interactions. Many case reports describe the antagonistic effects of NSAIDs on diuretics and antihypertensive drugs. The combination of triamterene and indomethacin appears particularly hazardous as it may result in acute renal failure. NSAIDs may also interfere with the beneficial effects of diuretics and ACE inhibitors in heart failure. It is not unusual to see patients whose heart failure has deteriorated in spite of increased doses of frusemide who are also concurrently taking an NSAID. 

Polyuria, polydipsia, tremor, ataxia, nausea, diarrhea, weight gain, drowsiness, acne, hair loss Possible effects on thyroid and renal functioning with longterm administration Children prone to dehydration are at higher risk for acute lithium toxicity... 

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